Interactive Theories

Hildegard E. Peplau

Theory of Interpersonal Relations

Regarded as “mother of psychiatric nursing”

Born in September 1,1909 at Reading, Pennsylvania

Graduated from a diploma program in Pottstown, Pennsylvania in 1931

- (OR nurse supervisor)

BA in interpersonal psychology from Bennington College in 1943

MA in psychiatric nursing from Colombia University, New York in 1947

EdD in curriculum development in 1953

Professor emeritus from Rutgers University

Started first post baccalaureate program in psychiatric nursing

Certified in psychoanalysis by William Alanson White Institute of New York City

Worked as executive director and president of ANA

Worked with WHO, and nurse corps

Died – March 7, 1999

Publications

In 1952 published Interpersonal Relations in Nursing

One of her first books that stated the need to emphasize importance of N-P relationship in providing hlt care

Credited with transformation of nursing from a group of skilled workers to a profession

Historical Evolution of the Theory

1943-45 served in the Army Nurse Corps

312th Field Station Hospital in England

American School of Military Psychiatry

Worked with leading figures in British and American psychiatry

After war worked to reshape mental health system in U.S.

Passage of National Mental Health Act of 1946

Purpose

The purpose of this theory is to facilitate the development of problem solving skills, within the context of the interpersonal relationship between nurse and client, using education and therapeutic interactions

Peplau felt that nursing was a healing art and an interpersonal process between two or more people with a common goal

Psychodynamic nursing facilitates

Understanding of one’s own behavior

Helping others identify felt difficulties

Nurse-patient relationship as partners

Application of human relations to problems at all levels of experience

Uniqueness

Theory was considered revolutionary at the time of development

Nursing as a profession, not just a skill

Made the way for psychiatric nursing specialty

Concepts and Definitions

Person

Environment

Health

Nursing

Person

A developing organism that tries to reduce anxiety caused by needs

An individual is made of physiological, psychological and social spheres striving towards equilibrium in life

Environment

Existing forces outside of the individual

Being and occurring in the context of the nurse client relationship ( norms, customs and beliefs)

Health

Peplau didn't include an exact definition of health within her model.

Peplau viewed health as "a word symbol that implied forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living".

Needs are physiological demands and interpersonal conditions.

Nursing

An educative and therapeutic relationship in which the nurse makes the client a partner in their health care and promotion

A significant therapeutic interpersonal process

Concepts and Definitions

Roles of the Nurse

Stranger

Teacher

Resource Person

Counselor

Leader

Surrogate

Structure

Four phases of the interpersonal relationship

Orientation

Identification

Exploitation

Resolution

Orientation

Nurse-Client, strangers

Felt need/Define problem

Trust and empowerment

Encourage active participation

Nurse determines what help client needs

Factors influencing orientation phase

Identification

Identify problems to be worked on during the relationship

Clarify perceptions and expectations

Level of dependence/independence

Selection of professional assistance

Capability to deal with identified problem/s

Decreases helplessness and hopelessness

Exploitation

Client utilizes all available services

Plan is implemented and evaluated

Continued assessment and assisting new needs of client

Fluid with implementation phase: together called working phase.

Resolution

Clients needs met

Mutual termination of relationship

Goal, support systems, problem prevention

Independence

Assumptions

Both nurse and patient want an interpersonal relationship

The patient is able to participate in an interpersonal relationship

The interpersonal relationship will enhance self maturity and/or self fulfillment

The patient has a felt need

Internal Criticism

Clarity

Concepts defined

Concepts consistent

Simplicity

Simple in nature, yet generalize

Definitions not clearly defined

logical systematic way of viewing nursing situations (based on 4 phases of NPR

Generality

Multi-use

Can apply to any nurse-patient relationship ( except comatose)

Accessibility

Easily accessible to practitioners to guide and improve their practice

Empirical Precision

Provides a theory based on reality. Tested and observed using pure observation

Derivable Consequences

Her thought, works and ideas have greatly touched the lives of many patients and nurses, from students to practitioners.

Importance of the Theory to Nursing

Understanding of one’s own behavior

Integrates into any area of nursing

Adaptability in any nurse patient relationship with the end purpose of meeting the patients needs

Case Study

Example of Peplau’s theory at work:

Scenario common to ED’s: 54 yr old male to ED with CC of abd pain for 3 days with N/V. Pt with hx of pancreatitis and ETOH abuse.

Let’s look at the 4 phases with this pt

Orientation: Problem defining phase

Introductions : Nurse as stranger

Asking questions

Client conveys needs, expectations

Nurse helps client identify problem: abd pain, N/V and alcohol abuse

Identification: Nurse as counselor and advocate

Identify problems to be addressed

N/V and abd pain: conveyed by pt

Education and resources for alcohol abuse

Exploitation: Nurse as teacher, resource person, advocate and mediator

Utilize available services and implement plan

Lab, CT, X-ray, MD

Continue to assess and re-evaluate

Resolution:

Termination of relationship

Pt has all needs met: pt with abd pain and N/V resolved

Pt with a plan for health maintenance: ie teaching and resources for alcohol abuse